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Scale for the Assessment of Negative Symptoms (SANS)3

Scale for the Assessment of Negative Symptoms (SANS) Test

Understand negative symptoms like apathy, flat affect, and low speech in about 5 minutes. A 25-item, structured format supports consistent ratings and clear tracking over time.

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Questions: 255 minutes

08:30

October 2, 2025

October 2, 2025
Material has been updated

October 2, 2025
Material has been published

20,088 views

1,737 completions

1,411 likes

Verified by Daniel Hall

Psychologist with 25 years of experience

Scale Explorer

How the Scales are Structured

example score

3/5

Anhedonia (Global Score) (AS)

Assesses the clinician-rated degree of reduced interest and diminished ability to experience pleasure from activities.

Low

Moderate

High

0 – 1: Low | 2 – 3: Moderate | 4 – 5: High

A score of 3 falls in the Moderate range, indicating a noticeable reduction in interest and pleasure relative to typical functioning.

example score

3/5

Avolition (Global Score) (AS)

This scale rates the clinician-observed severity of reduced motivation, willpower, and initiation of goal-directed activity (abulia).

Low

Moderate

High

0 – 1: Low | 2 – 3: Moderate | 4 – 5: High

A score of 3 falls in the Moderate range, indicating a noticeable reduction in energy and initiative that can interfere with everyday activities.

example score

3/5

Alogia (Global Score) (AS)

Assesses the clinician-rated severity of reduced speech output and impoverished thought processes (alogia).

Low

Moderate

High

0 – 1: Low | 2 – 3: Moderate | 4 – 5: High

A score of 3 indicates a moderate level of alogia, with noticeable reductions in spontaneity and amount of speech.

example score

7/20

Anhedonia (A)

Assesses reduced capacity to experience pleasure and interest in typical activities, especially social engagement.

Low

Moderate

High

0 – 6: Low | 7 – 13: Moderate | 14 – 20: High

A score of 7 falls in the Moderate range, indicating a noticeable reduction in pleasure or interest across usual activities.

example score

2/5

Affective Flattening (Global Score) (AFS)

This scale quantifies the clinician-observed reduction in the patient's emotional expressiveness (affective flattening).

Minimal/none

Mild–moderate

Marked–severe

0 – 1: Minimal/none | 2 – 3: Mild–moderate | 4 – 5: Marked–severe

A score of 2 indicates a mild to moderate reduction in observable emotional expression during interaction and observation.

example score

2/5

Attention Impairment (Global Score) (AIS)

This scale reflects the clinician’s overall impression of the severity of concentration and sustained-attention difficulties based on observation and interview.

None–Minimal

Mild–Moderate

Marked–Severe

0 – 1: None–Minimal | 2 – 3: Mild–Moderate | 4 – 5: Marked–Severe

A score of 2 falls in the Mild–Moderate range, suggesting noticeable but not severe difficulties with maintaining attention.

example score

7/25

Total Summary Score (TSS)

This scale summarizes the clinician’s overall impression of the severity of negative symptoms based on observation and dialogue.

Low severity

Moderate severity

High severity

0 – 8: Low severity | 9 – 16: Moderate severity | 17 – 25: High severity

A total score of 7 falls in the Low severity range, suggesting a relatively mild overall level of observed negative symptoms on this assessment.

example score

43/100

Sum of Subscale Scores (SoSS)

This scale sums intermediate SANS ratings to quantify the overall severity of observed negative symptoms.

Low

Moderate

High

0 – 33: Low | 34 – 66: Moderate | 67 – 100: High

A score of 43 falls in the Moderate range, indicating a moderate overall severity of the negative symptoms captured by the intermediate ratings.

example score

8/10

Attention Impairment (AI)

Measures observable difficulties with focusing, sustaining attention, and resisting distraction during tasks or conversation.

Low

Moderate

High

0 – 3: Low | 4 – 6: Moderate | 7 – 10: High

A score of 8 falls in the High range, indicating marked distractibility and reduced ability to maintain attention in observed interactions.

example score

12/15

Avolition (A)

Assesses the severity of abulia, reflecting reduced drive, initiative, and goal-directed activity without prominent depressive affect.

Low

Moderate

High

0 – 5: Low | 6 – 10: Moderate | 11 – 15: High

A score of 12 falls in the High range, indicating marked and persistent reductions in motivation and initiative with likely impact on everyday functioning.

example score

9/20

Alogia (A)

Assesses the severity of reduced speech output and impoverished verbal thought content (alogia) observed during interaction.

Low

Moderate

High

0 – 6: Low | 7 – 13: Moderate | 14 – 20: High

A score of 9 falls in the Moderate range, indicating noticeable but not extreme reductions in speech amount and/or content during observation.

example score

10/35

Affective Flattening (AF)

Assesses reduced emotional expressiveness and responsiveness as observed in behavior and reactions.

Low

Moderate

High

0 – 11: Low | 12 – 23: Moderate | 24 – 35: High

A score of 10 falls in the Low range, suggesting relatively mild observed reduction in emotional expressiveness and responsiveness.

example score

47/125

Total Score (TS)

This scale quantifies the overall severity of negative symptoms such as reduced emotional expression, poverty of speech, low motivation, diminished pleasure, and attention deficits.

Low

Moderate

High

0 – 29: Low | 30 – 60: Moderate | 61 – 125: High

A score of 47 falls in the Moderate range, indicating a noticeable but not extreme overall level of negative symptom severity on the SANS.

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DATA-BASED USER COHORTS

Who Usually Takes This Test?

Psychiatrists in clinical practice

44%OF USERS

They use the scale to quickly rate negative symptoms in schizophrenia-spectrum disorders and track changes during treatment.

Clinical psychologists and therapists

33%OF USERS

They complete it during structured observation and interviews to document emotional flattening, apathy, and reduced speech.

Residents and mental health trainees

23%OF USERS

They take it to learn a standardized, quantitative way to recognize and communicate negative symptoms within a care team.

BASED ON AGGREGATED, ANONYMIZED DATA FROM TENS OF THOUSANDS OF FREUDLY USERS.

Benchmarking

See How You Compare

Once you complete the test, your results are compared with real-world data from people in your country.
Below is a preview of how scores are typically distributed across each scale.

Anhedonia (composite score) (A(s)

Average

2.3

Normal range

1.4 — 3.1

min.

max.

This curve shows how scores are typically distributed.
Once you complete the test, your result will appear on the scale so you can see how you compare.

Abulia (overall score) (A(s)

Average

3.2

Normal range

2.3 — 4.1

min.

max.

This curve shows how scores are typically distributed.
Once you complete the test, your result will appear on the scale so you can see how you compare.

Alogia (General Score) (A(S)

Average

2.9

Normal range

2.1 — 3.6

min.

max.

This curve shows how scores are typically distributed.
Once you complete the test, your result will appear on the scale so you can see how you compare.

Anhedonia (A)

Average

8.5

Normal range

5 — 12.1

min.

max.

This curve shows how scores are typically distributed.
Once you complete the test, your result will appear on the scale so you can see how you compare.

Affective flattening (composite score) (Af(s)

Average

Normal range

1.4 — 2.7

min.

max.

This curve shows how scores are typically distributed.
Once you complete the test, your result will appear on the scale so you can see how you compare.

Attention Disorders (Composite Score) (AD(S)

Average

2.2

Normal range

1.4 — 3.1

min.

max.

This curve shows how scores are typically distributed.
Once you complete the test, your result will appear on the scale so you can see how you compare.

Total of aggregated scores (Toas)

Average

12.1

Normal range

7.9 — 16.2

min.

max.

This curve shows how scores are typically distributed.
Once you complete the test, your result will appear on the scale so you can see how you compare.

Sum of intermediate scores (Sois)

Average

66.5

Normal range

52 — 80.9

min.

max.

100

This curve shows how scores are typically distributed.
Once you complete the test, your result will appear on the scale so you can see how you compare.

Attention Disorders (AD)

Average

5.6

Normal range

4.1 — 7.1

min.

max.

This curve shows how scores are typically distributed.
Once you complete the test, your result will appear on the scale so you can see how you compare.

Abulia (A)

Average

8.9

Normal range

6.4 — 11.4

min.

max.

This curve shows how scores are typically distributed.
Once you complete the test, your result will appear on the scale so you can see how you compare.

Alogia (A)

Average

10.3

Normal range

7 — 13.6

min.

max.

This curve shows how scores are typically distributed.
Once you complete the test, your result will appear on the scale so you can see how you compare.

Affective Flattening (AF)

Average

12.7

Normal range

8.2 — 17.3

min.

max.

This curve shows how scores are typically distributed.
Once you complete the test, your result will appear on the scale so you can see how you compare.

Overall score (Os)

Average

55.1

Normal range

37.4 — 72.8

min.

max.

125

This curve shows how scores are typically distributed.
Once you complete the test, your result will appear on the scale so you can see how you compare.

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SAMPLE QUESTIONS

Example Questions From the Test

Symptom ratings should be completed by one, or preferably two, experienced raters who are thoroughly familiar with the scale’s glossary. At hospital admission and during the initial assessment, symptoms are rated for the month preceding hospitalization. To evaluate treatment effectiveness, the scale may be administered weekly or less frequently; in such cases, ratings should cover the interval since the previous assessment.

- Absent: facial expression is completely lively
- Questionable reduction in facial expressiveness and animation
- Mild: facial expressiveness is slightly reduced, or the face becomes fixed intermittently
- Moderate: facial expressiveness is clearly reduced
- Marked reduction in facial expressiveness, but facial reactions may occur at times
- Severe: the face is a fixed (“wooden”) mask that does not change during the interview
- Absent
- Questionable pathology
- Mild – one episode of blocking in 15 minutes
- Moderate – two episodes in 15 minutes
- Marked – three episodes of speech blocking in 15 minutes
- Severe – more than three episodes in 15 minutes
- absent
- questionable pathology
- mild but definite
- moderate
- marked pathology
- severe

These are 3 of the 25 real questions — the rest appear in the test. No sign-up needed to start.

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WHAT THE TEST MEASURES

About This Assessment

Scale for the Assessment of Negative Symptoms (SANS) Test - Symptoms and Signs

psychopathology

schizophrenia

In clinical evaluation of psychotic-spectrum conditions, negative symptoms may be less apparent than positive symptoms but can substantially affect functioning. The Scale for the Assessment of Negative Symptoms (SANS) is a clinician-rated measure designed to systematically assess the presence and severity of core negative symptom domains based on interview and behavioral observation. It was developed by Nancy C. Andreasen.

The instrument includes 25 items and typically takes about 5 minutes to complete. Ratings support quantification of symptom severity and can be used to document baseline presentation and to track change over time; the Scale for the Assessment of Negative Symptoms (SANS) is commonly incorporated into broader diagnostic and treatment-monitoring assessments.

Author: Nancy C. Andreasen

Literature: Andreasen, N. C. The Scale for the Assessment of Negative Symptoms (SANS): conceptual and theoretical foundations. The British Journal of Psychiatry. Supplement. 1989.; Kirkpatrick, B., Fenton, W. S., Carpenter, W. T., & Marder, S. R. The NIMH-MATRICS consensus statement on negative symptoms. Schizophrenia Bulletin. 2006.